Shelby County Health Care Corp. v. Majestic Star Casino, LLC Group Health Benefit Plan, No. 08-6078

In plaintiff's case against a benefit plan administrator for denying its claim for benefits under ERISA, district court's judgment is affirmed in part and reversed in part where: 1) district court did not err in applying the de novo standard of review in concluding that the third-party administrator for the plan rather than defendant made the decision to deny the claim for benefits; 2) district court properly concluded that defendant erred in denying the claim as the court correctly determined that the benefits for which the claimant sought payment did not stem from a loss caused by driving without a license and driving without insurance, for purposes of an exclusionary clause in the plan; 3) district court properly awarded benefits and prejudgment interest to plaintiff; and 4) award of attorney's fees is reversed as the district court erred in weighing the first factor of the five-factor test in favor of a fees award. 

Read Shelby County Health Care Corp. v. Majestic Star Casino, LLC Group Health Benefit Plan, No. 08-6078

Appellate Information

Argued: June 16, 2009

Decided and Filed: September 21, 2009

Judges

Opinion by Judge Clay 

Counsel

For Appellant:  David A. Thornton, Bass, Berry & Sims PLC

For Appellee:  Curtis Henry Goetsch, McCullough & McCullough, PLLC